vaccines in special population and others

what are 4 recommended vaccines to get during pregnancy

1. Tdap for every pregnancy, during 27-36 weeks

2. inactivated or recombinant influenza vaccine

3. RSV (Abrysvo) during 32-36 weeks

4. COVID-19

what are 2 causes of immunosuppression

1. disease (cancer, diabetes, HIV, leukemia)

2. drug therapy to suppress immunity (chemo, arthritis, kidney transplant on prednisone)

what are types of immunosuppression (8)

1. congenital immunodeficiency

2. cancer

3. hematopoietic stem cell transplant pt

4. solid organ transplant pt

5. asplenia or sickle cell disease

6. hiv infection

7. radiation/chemo therapy

8. immunosuppressive medications

   1. systemic corticosteroid therapy, monoclonal antibodies, TNF/IL inhib, interferon

when should live and inactivated vaccines be given before suppression

4 weeks prior to immunosuppression and no sooner than 2 weeks

what are screening questions for adult pt

• are you sick today

• do you have allergies to medications, food, a vaccine component or latex

• have you had a serious rxn after receiving vaccination

• screen for other indications/immunosuppression

what are epinephrine doses and what are they based on? how many doses should be available

• based on 1:1000 w/v, 1 mg/mL

• dosing by body weight = 0.01 mg/kg/dose

• dosed 5-15 min for up to 3 doses

how long should you observe pt after vaccination

15 min

what is vasovagal syncope and its symptoms

brief loss of consciousness or fainting

• most occur in 5-15 min in teens/women more

• symptoms: paleness, sweat, cold hands/feet, nausea, dizzy, weak. visual disturb

what are 5 things you should do if pt faints after vaccination

1. follow emergency response protocol

2. help pt to ground so they don’t fall and injure

3. lay pt flat on floor with feet elevated

4. if pt don’t regain consciousness quickly, call 911

5. report to VAERS

when would it be necessary to administer repeat doses of epinephrine for severe allergic rxn after vaccinations

if pt hasn’t properly responded

what is the usual interval between epinephrine doses

every 5-15 min

what are 4 things you should do while communicating with pt

1. confident and presumptive recommendation

2. open-ended question to learn abt pt concerns

3. reflect and validate concerns to show you understand

4. address concerns to build trust that makes future care possible

how do you prepare vaccine doses from vials (6)

1. remove protective cap

2. swab top of vial with alcohol and let it dry to kill germs

3. pull back plunger to draw air into syringe equal to designated volume for injection

4. insert syringe into vial and inject air to displace volume to be withdrawn

5. turn vial and syringe upside down and withdraw dose

6. ensure large air bubbles don’t exist (small are ok)

which of the vaccines we know are reconstituted

RSV: dry powder, add liquid and shake to reconstitute

what is the shoulder injury related to vaccine administration (SIRVA)

• associated with vaccine given to high on arm

where should the injector be and where should they target

• be at same level as pt

• should target lower two-thirds of deltoid muscle

where should subcutaneous injection target

outer aspect of upper arm (posterolateral)

what inch, gauge, angle should subcutaneous injection be?

• 5/8 inch

• 23-25 gauge

• insert at 45 degree

Which of the following is true regarding the intranasal administration of the LAIV?

A. Instruct the patient sniff or inhale during administration.

B. Insert tip of the sprayer just inside the nose and depress the plunger to spray the full dose into one nostril.

C. There is no need to repeat the dose if sneezing or coughing occur.

D. The LAIV is the preferred product to be administered annuall

C. There is no need to repeat the dose if sneezing or coughing occur.